Section 83-1.12 - Prohibited practices-additional requirements

83-1.12 Prohibited practices-additional requirements.

(a) The fee for letting of space, provision of services by supporting staff and employees, use or control of equipment or for other considerations necessary for the provision of medical care and services shall not be calculated or paid as a percentage of the earnings or billings of the providers or purveyors for services rendered on the facility premises.

(b) No purveyor, whether or not located in a building which houses a shared health facility shall directly or indirectly offer, pay or give to any provider, and no provider shall directly or indirectly solicit, request, receive or accept from any purveyor any sum of money, credit or other valuable consideration for:

(1) recommending or procuring goods, services or equipment of such purveyor; or (2) directing patronage or clientele to such purveyor; or

(3) influencing any person to refrain from using or utilizing goods, services or equipment of any purveyor.

(c) No provider or purveyor shall demand or collect from any patient compensation for care or services in excess of the fee specified in the appropriate program fee schedule.

(d) No purveyor shall provide to a patient eligible to receive or receiving benefits under the provisions of the program any services, equipment, pharmaceutical or other medical supplies differing in quantity in any other respect from that described in the payment invoice submitted by such purveyor to the department. No purveyor shall provide to any patient eligible to receive or receiving under the provisions of the program any services, equipment, pharmaceutical or medical supplies differing in quality, quantity or in any other respect from that prescribed by the provider.

(e) No provider or purveyor in a shared health facility or person employed in a facility shall refer a patient to another provider or purveyor located in such facility unless there is a medical need for such referral and unless the records of the referring provider or purveyor pertaining to such patient clearly sets forth the justification for such referral.

(f) Every provider or purveyor practicing in a shared health facility who treats a patient referred to him by another provider practicing in the same facility shall communicate in writing to the referring provider the diagnostic evaluation and the therapy rendered. The referring provider or purveyor shall incorporate such information into the patient's permanent record.

(g) The invoice submitted to the program by the provider or purveyor to whom such patient has been referred shall:

(1) contain the name and program number of the referring provider or purveyor; and

(2) identify the medical problem or condition which necessitated the referral.

(h) All provider and purveyor invoices submitted to the program for reimbursement for services rendered at a shared health facility shall:

(1) contain the registration code of the facility at which the service was performed;

(2) clearly identify the provider or purveyor who provided the service; and

(3) be signed by the provider or purveyor only after the service has been performed.

(i) Invoices submitted to the program for care, supplies or services rendered at a shared health facility lacking a valid, current registration issued by the department are not eligible for reimbursement by the program.

(j) All orders issued by providers for ancillary clinical services, including but not limited to x-rays, electrocardiograms, clinical laboratory services, electroencephalograms, as well as orders for medical supplies and equipment, shall contain the registration number assigned to the facility at which the order was written.

(k) Any pharmacy maintaining a business in or adjacent to the building in which a shared health facility is located shall prominently post a notice informing patients that all pharmaceuticals prescribed in the program may be obtained at any pharmacy of the patient's choice enrolled in the program.

(l) No purveyor who maintains a business in the building in which a shared health faculty is located shall maintain a door or window opening into the space occupied by the facility, except where the profession of a provider permits the provider to function simultaneously as a purveyor.

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